Current Recommendations For Hormone Therapy
The US FDA has approved HT for the following indications:
- Vasomotor symptoms in menopause. HT is considered first-line therapy for these symptoms unless contraindications exist.
- Prevention of bone loss and reduction of fractures in post-menopausal women.
- Prevention of bone loss, and provision of health benefits for treatment of menopausal symptoms, cognition and mood and heart disease in women with premature ovarian failure, hypogonadism or early surgical menopause who have no other contraindications to HT.
- Treatment of genitourinary symptoms and vulvovaginal atrophy.
The findings of older studies, such as the WHI, do not apply to younger menopausal women who have no other contraindications to HT. The failure to consider and appropriately prescribe HT to younger women with premature or surgical menopause may result in adverse events for them at older ages.
The use of HT for other potential benefits may be instituted following discussion of management options and exclusion of hormone contraindications. Benefits may outweigh risks for women who accept slightly more risks for the benefits.
Reappraisal of hormone dose and delivery route over time in menopausal women allows use of the lowest dose of HT to provide treatment benefits and minimize risks
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What Are The Benefits Of Hormone Replacement Therapy
As we age, our bodies naturally produce lower levels of hormones, particularly estrogen and testosterone. Because the endocrine system affects nearly every part of the body, hormone replacement therapy may help reduce risk for a variety of common chronic ailments associated with age. This includes:
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Estrogen Side Effects And Risks
Hormone therapy is not without its risks. In fact, hormone therapy is not used as widely as it once was because research began revealing complications with long-term use, such as cancer and heart risks.
However, thanks to these studies, doctors and medical researchers have a better understanding of who will benefit most from estrogen therapy and who should try other treatments.
The risk factors and side effects associated with estrogen use include:
- Blood clots: Estrogen increases your risk of blood clots, which can cause stroke, heart attack, and even death.
- Cancer: Estrogen may increase your risk of certain cancers, specifically breast cancer. Talk with your doctor about your personal health history, your family history, and your risk of breast cancer.
- Birth defects: If youre using estrogen or hormone therapy and become pregnant, your pregnancy may end prematurely. If youre able to carry a pregnancy to full term, birth defects are common for babies born to women using estrogen.
- Dense breast tissue: Women who take estrogen may develop dense breast tissue. Dense tissue makes reading mammograms harder, so detecting breast cancer in its early stages may be difficult.
A Note From Cleveland Clinic
The decision to take hormone therapy needs to be a very personalized one. Hormone therapy is not for everyone. Discuss the risks and benefits of hormone therapy with your healthcare provider at an office visit specifically dedicated for this conversation. Youll need the time to address all the issues and answer questions in order to arrive at a decision that is best for you. Factors considered should be your age, family history, personal medical history and the severity of your menopausal symptoms.
Be sure to talk about the pros and cons of the different types and forms of HT as well as non-hormonal options such as dietary changes, exercise and weight management, meditation and alternative options.
Frequently Asked Questions Expand All
When progestin is added, it can come in different forms, including pills you take by mouth, or tablets and gels you place in the vagina. The intrauterine device , which releases progestin, also may be an option. Progestin also can be combined with estrogen in the same pill or patch.
You and your obstetriciangynecologist can talk about what form may work best for you. You can decide based on your symptoms, medical history, and lifestyle.
Estrogen-only therapy is taken daily. There are two ways to combine estrogen and progestin for women who still have a uterus:
Continuous-combined therapy: Both estrogen and progestin are taken every day.
Cyclic therapy: Estrogen is taken daily. Progestin is added for 10 to 14 days each month . Another name for this is sequential hormone replacement therapy.
You and your ob-gyn can discuss the approach that works best for you.
Talk with your ob-gyn about what may work best for you based on your symptoms and your personal and family medical history. If you decide to take hormone therapy, you and your ob-gyn should talk every year about whether to continue hormone therapy. Each year, this decision will depend on your symptoms, risks, and benefits. Some women may need longer therapy if their symptoms go on for a long time.
Both systemic and local estrogen therapy relieve vaginal dryness.
Breast or endometrial cancer
How Long Does It Take To Reach Female Estrogen Levels On Hormone Replacement Therapy
As we age, our bodies go through changes like hormonal imbalance that leads to different health concerns and painful symptoms. For some women, hormone replacement therapy is the best way to restore the estrogen levels in their bodies and relieve symptoms that come with estrogen deficiency.
But how long does it take for the female estrogen levels to return to normal after taking HRT? Different types of HRT take different times to affect the bodys hormone levels, but most of them work within a few weeks. Since the body takes time to adjust to the HRT, it might take around a few months for patients to feel the full effects of menopausal hormone therapy.
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These Run The Gamut From Sleep Apnea Acne Oily Skin And Potential Blood Clots
What is hormone replacement therapy for male. Bioidentical is used to convey that the molecular structure is the same as the hormones produced by the human body. The goal of natural hormone replacement therapy is to restore and maintain hormone balance with hormones that have similar chemical structures to the hormones produced by the human body. Testosterone replacement can be highly effective for men who have the signs of andropause male menopause which begins as early as 30 in some.
Testosterone affects numerous bodily systems and is responsible for: Undoubtedly hrt for men offers several benefits,. Yet trt remains controversial because of its uncertain benefits and potential health risks.
Bhrt stands for bioidentical hormone replacement therapy, the type of therapy biote certified providers use. The therapy used resembles hormone replacement regimens used to treat natal men with hypogonadism and most of the preparations are testosterone esters. In most instances, hormone replacement therapy is employed to replenish diminished levels of testosterone, the primary reproductive hormone the male body produces.
Testosterone replacement therapy has surged in popularity over the past decade. So, hormone therapy doesnt replace anything that is naturally. Testosterone replacement therapy can help older men deficient in the hormone reduce their risks of heart disease, diabetes and death, researchers say.
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What Is Hormone Therapy
As a woman approaches menopause, the production of estrogen and progesterone fluctuates and then decreases significantly. Symptoms such as hot flashes often result from the changing hormone levels. After a woman’s last menstrual period, when her ovaries make much less estrogen and progesterone, some symptoms of menopause might disappear, but others may continue.
To help relieve these symptoms, some women use hormones. This is called menopausal hormone therapy . This approach used to be called hormone replacement therapy or HRT. MHT describes several different hormone combinations available in a variety of forms and doses.
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Womens Health Initiative Studies Of Hormone Therapy And Cancer Risk
Several large studies have looked at possible links between systemic hormone therapy in menopausal women and different types of cancer.
The main randomized studies of MHT were part of the Womens Health Initiative . The WHI included 2 randomized placebo-controlled clinical trials of MHT in healthy women:
- One study looked at estrogen therapy in post-menopausal women who didnt have a uterus. Over 5,000 women in the ET group took a daily dose of estrogen in the form of conjugated equine estrogen for an average of about 6 years. The researchers then continued to follow them for several years to look for any further effects of the hormone. The women were compared to more than 5,000 in the placebo group.
- The other study looked at estrogen-progestin therapy in post-menopausal women who still had their uterus. Over 8,500 women in the EPT group took a daily dose of CEE plus a progestin called medroxyprogesterone acetate for an average of about 5 years. This group was compared to a group of more than 8,000 women in the placebo group.
The WHI also conducted some observational studies. However, when we mention a WHI study below, were referring to one of the randomized studies.
Types Of Hormone Replacement Therapy And How Long Before They Take Effect
Estrogen is an important hormone in the body that affects female development and the menstrual cycle. Its production in the female body naturally declines over time, but around 1% of women experience premature menopause and decreased estrogen levels earlier than normal. This puts them at risk of different health conditions including neurological diseases, cardiovascular diseases, several cancer types, osteoporosis, and more.
To prevent these risks and restore the normal level of estrogen in the body, women are often recommended to undergo hormone replacement therapy. This treatment comes in different types which take different times to take effect.
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What Hormones Are Used To Treat The Symptoms Of Menopause
The hormones most commonly used to treat symptoms of menopause are estrogen and progesterone. . Often, these 2 hormones are used together, but some women are given estrogen alone. Its important to know which hormones you are talking about when looking at the risks.
Common estrogen preparations used to treat menopausal symptoms include conjugated equine estrogens and estradiol, but several forms or types of estrogen are available.
There are also many progestins available, but medroxyprogesterone acetate , is often used with an estrogen to treat menopausal symptoms. Some preparations contain both an estrogen and a progestin.
Androgens are also sometimes used to treat menopausal symptoms. This is not common, though, and because only a few studies have looked at this practice, it isnt clear how safe it is in the long run.
Tibolone is a synthetic hormone drug that can act like estrogen, progesterone, and testosterone in different tissues of the body. Because this drug isnt available in the US, its not discussed here.
What Are Some Commonly Used Postmenopausal Hormones
The following list provides the names of some, but not all, postmenopausal hormones.
- Pills, Brand names: Cenestin®, Estinyl®, Estrace®, Menest®, Ogen®, Premarin®, Femtrace®.
- Creams, Brand names: Estrace®, Ogen®, Premarin®.
- Vaginal ring,Brand names: Estring®, Femring® .
- Vaginal tablet, Brand names: Vagifem®. Imvexxy®
- Patch, Brand names: Alora®, Climara®, Minivelle®, Estraderm®, Vivelle®, Vivelle-Dot®, Menostar®.
- Spray, Brand name: Evamist®.
- Modest improvement in joint pains.
- Lower death rate for women who take hormone therapy in their 50s.
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How Do I Know If Hormone Replacement Therapy Is Right For Me
Your doctor can help you weigh the pros and cons and suggest choices based on the severity of your symptoms and your medical history.
Here are some questions to ask:
- Based on my medical history, is there any reason I shouldnât use HRT?
- Do you think it could help my symptoms, especially hot flashes, sleep issues, and vaginal dryness?
- Are there other treatments I should consider?
- Do you think Iâll have side effects from HRT?
- Does my family medical history make me a good or bad candidate for HRT?
- What type of HRT might be best for me?
How Can I Reduce These Side Effects Of Hormone Therapy
In most cases, these side effects are mild and dont require you to stop your HT. If your symptoms bother you, ask your healthcare provider about adjusting either the dosage or the form of the HT to reduce the side effects. Never make changes in your medication or stop taking it without first consulting your provider.
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Other Factors To Remember:
Hormone replacement therapy works very well and has multiple different options you can choose from. Based on the cost of just the prescription, you may want to say the pills are your best bet. However, we want you to remember that there are other factors involved.
The cost of the doctors visit is not in the price of the prescription. If you have a co-pay for a doctors appointment, this can quickly add up to hundreds of extra charges for your therapy.
The same is true with bloodwork to monitor your levels. You have to pay for these tests, as many insurance companies have caps on how many blood tests they will pay for in a given year.
Signs And Symptoms Of High Estrogen
What is estrogen?
Your bodys hormones are like a seesaw. When theyre perfectly balanced, your body works as it should. But when theyre unbalanced, you may begin experiencing problems.
Estrogen is known as the female hormone. Testosterone is known as the male hormone. Although each hormone is identified with a specific sex, both are found in women and men. On average, women have higher levels of estrogen and men have more testosterone.
In women, estrogen helps initiate sexual development. Along with another female sex hormone known as progesterone, it also regulates a womans menstrual cycle and affects her entire reproductive system. In premenopausal women, estrogen and progesterone levels vary from one stage of the menstrual cycle to another.
In men, estrogen also plays an important role in sexual function.
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How Long Should I Take Hormone Therapy
In general, there is no time limit to how long you can take hormone therapy. You should take the lowest dose of hormone therapy that works for you, and continue routine monitoring with your healthcare provider to reevaluate your treatment plan each year. If you develop a new medical condition while taking HT, see your provider to discuss if its still safe to continue taking HT.
Forms Of Hormone Therapy
HT comes in different forms. You may need to try different types before finding one that works best for you.
Estrogen comes in:
- Pills or tablets, taken by mouth
- Skin gel
- Skin patches, applied to the thigh or belly
- Vaginal creams or vaginal tablets to help with dryness and pain with sexual intercourse
- Vaginal ring
Most women who take estrogen and who still have their uterus also need to take progestin. Taking both hormones together lowers the risk of endometrial cancer. Women who have had their uterus removed cannot get endometrial cancer. So, estrogen alone is recommended for them.
Progesterone or progestin comes in:
- Vaginal suppositories
- Intrauterine device or intrauterine system
The type of HT your doctor prescribes may depend on what menopause symptoms you have. For example, pills or patches can treat night sweats. Vaginal rings, creams, or tablets help relieve vaginal dryness.
Discuss the benefits and risks of HT with your provider.
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What Questions Remain In This Area Of Research
The WHI trials were landmark studies that have transformed our understanding of the health effects of MHT. Its important to note that women who were enrolled in the WHI trials were, on average, 63 years old, although about 5,000 of them were under age 60, so the results of the study may also apply to younger women. In addition, the WHI trials tested single-dose strengths of one estrogen-only medication and one estrogen-plus-progestin medication .
Follow-up studies have expanded and refined the original findings of these two trials. But many questions remain to be answered:
- Are different forms of hormones, lower doses, different hormones, or different methods of administration safer or more effective than those tested in the WHI trials?
- Are the risks and benefits of MHT different for younger women than for those studied in the WHI trials?
- Is there an optimal age at which to initiate MHT or an optimal duration of therapy that maximizes benefits and minimizes risks?
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It is possible to use a credit card to pay for gender transition. However, you will need an acceptable credit history to get approved for a credit card in the first place. If you arent sure of your credit history, Experian offers free credit score and credit report checks. Its also unwise to use a credit card to make payments if you wont be able to afford your credit card bill at the end of the month. Credit cards tend to have very high interest rates compared to other forms of debt and companies tend to slap on wherever they can. If you do decide to use a credit card to pay for your gender transition, use is sparingly and pay off your entire balance as quickly as possible.
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